Admissions Forms | Germanna Community College

Form Instructions

Please follow the listed steps below to complete and submit the available forms.

Complete the requested form information, date and type your full name as your signature and click 'Email Form to Admissions' button at the bottom of the form.
Note: Required field titles are in red.

If a required field or formatted field is formatted incorrectly or missing, please correct and click 'Email Form to Admissions' again.

Repeat above step until submission is accepted with no validation prompts.

Contact Information

First Name

Middle

Last Name

Preferred Phone *Enter as xxx-xxx-xxxx

GCC Student ID 7 Digit Student ID Required

Current Term

Current Year

Withdrawn after "W" Period with Mitigating Circumstances

Please list the course(s) for which you are seeking a refund

Class Number (i.e. 56278)	Course Subject (i.e. HIS)	Course Number (i.e. 101)	Credits (i.e. 3 credits)	Last Date Attended According to Faculty (i.e. January 10, 20XX)

Please check all that apply:

Are you receiving GI Bill Benefits?

Yes No

Are you receiving Grant Financial Aid?

Yes No

Are you receiving Direct Loans?

Yes No

Are you in the Nursing Partnership Program?

Yes No

If Yes and the request is approved , an updated transcript may be sent to UMW.

If you answered yes to any of these questions, you MUST discuss the impact this will have if you are approved AND a representative of that department must sign off before this form can be reviewed.

Please check the reason below for your withdrawal and send supporting documentation.

Personal or family illness

Geographic transfer or change in the hours or conditions of employment

Active duty military services

Other circumstances (please explain in the space provided)

Date Student Signature Date Required Type your signature Typed Signature is Required